Appropriateness of prostate-specific antigen testing

Am J Clin Pathol. 2000 Mar;113(3):421-8. doi: 10.1309/E11X-491Y-GUJH-EGGF.


We established criteria for appropriate use of the prostate-specific antigen (PSA) assay and used them to evaluate PSA test utilization at 1 tertiary care institution. During a 6-month period, 2,330 PSA results were reported for outpatients and 95 for inpatients. We reviewed medical records for a random sample of 338 outpatient results (14.51%) and all 95 inpatient results, of which 21% (71/338) of outpatient and 17% (16/95) of inpatient results were inappropriate according to our test utilization criteria. Among outpatients, 52% of tests were done for screening and 19% for monitoring for cancer recurrence. For inpatients, workup for cancer (53/95 [56%]) was the most frequent indication for testing and screening the second (24/95 [25%]). Of tests failing the criteria, 66 (76%) of 87 resulted from excessively frequent and age-inappropriate screening. We assessed the potential effect on clinical outcome if these tests were not performed. Of the 87 tests considered inappropriate, only 1 test result influenced clinical management for patients younger than 75 years. By instituting simple limits on age and frequency, we estimate that 74% (64/87) of the inappropriate tests could have been eliminated.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Boston
  • Cost-Benefit Analysis
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Mass Screening / economics
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Neoplasm Recurrence, Local / blood
  • Neoplasm Recurrence, Local / diagnosis
  • Outpatients
  • Prognosis
  • Prostate-Specific Antigen* / blood
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / diagnosis*
  • Utilization Review


  • Prostate-Specific Antigen